Low birth weight and the developing vascular tree: a systematic review

Low birth weight (LBW) is a risk factor for hypertension, stroke and coronary heart disease in adults. Mechanisms underlying cardiovascular disease may therefore be initiated in early life. Studies to investigate the initiating events and emergence of vascular risk markers in infancy and childhood have been an area of particular interest in recent years. The aim of this review is to focus on the early development of the human vascular tree in relation to LBW. Specific characteristics, including endothelial function, intima-media thickness, microvascular density, arterial dimensions and elasticity, will be discussed. LBW due to different causes--poor foetal growth or preterm birth--results in different patterns of altered development of the vascular system, which can already be seen in infancy. Follow-up studies in children and young adults indicate that vascular compromise in many ways persists in those born either small for gestational age or prematurely. CONCLUSION: LBW is associated with structural and functional changes in the vascular tree, which have implications for cardiovascular health in adult life.     

Programmable shunt valves for the treatment of hydrocephalus: A systematic review

ObjectiveTo evaluate the clinical effectiveness of programmable valves compared with non-programmable valves of hydrocephalus.MethodsIn this paper, the authors report a systematic review and meta-analysis of complications and revision rate for programmable valves and non-programmable implantation. Randomized or non-randomized controlled trials of hydrocephalus treated by programmable and non-programmable valves were considered for inclusion.ResultsSeven published reports of eligible studies involving 1702 participants meet the inclusion criteria. Compared with non-programmable, programmable valves had no significant difference in catheter-related complications [RR = 0.88, 95%CI (0.66,1.19), p = 0.10] and infection rate [RR = 1.25, 95%CI (0.92,1.69), p = 1.00]. There were significant differences in overall complications [RR = 0.80, 95%CI (0.67,0.96), p < 0.01], over-drainage or under-drainage complications [RR = 0.44, 95%CI (0.31,0.63), p < 0.01] and revision rate [RR = 0.56, 95%CI (0.45,0.69), p < 0.01] in favor of programmable valves.ConclusionAlthough the studies seem to demonstrate a small advantage for the programmable shunts, the probable bias and the difficulties in patient selection are too important to make a general conclusion.     

The definition of a haemodynamic significant duct in randomized controlled trials: a systematic literature review

Aim: A patent ductus arteriosus (PDA) is associated with morbidity in preterm infants. Treatment is prescribed for a haemodynamically significant duct (HSDA), but its definition varies. We systematically reviewed the clinical and ultrasound criteria used for the definition of an HSDA. Methods: PubMed and the Cochrane library were searched for randomized trials evaluating ductal treatment. The included studies were explored, and we categorized clinical and ultrasound criteria used to define an HSDA. Results: Sixty‐seven trials were included in our review. Forty‐two were placebo‐controlled trials, and 25 were comparative trials. The diagnosis of the PDA was made by clinical examination, followed by ultrasound in most trials. Most trials used clinical and ultrasound criteria to define an HSDA, but there was a wide variety in criteria and cut‐offs used. Of the clinical criteria, a murmur or hyperdynamic circulation was most used, and of the ultrasound criteria, the left‐atrium‐to‐aorta ratio (LA/Ao ratio) was most used. Conclusion: We found a wide variety in the definition of an HSDA. This finding implies that comparison of studies is difficult. International consensus should be reached on the definition of an HSDA, which will make future studies more comparable.     

新生儿危重症先天性心脏病筛查的卫生经济学系统评价

背景：新生儿危重症先天性心脏病（mCHD）筛查技术日臻成熟,然而成熟的技术要具有较好的经济性才可能被广泛接受和应用,目前相关研究不多,且大部分数据来源于发达国家。目的：探讨mCHD筛查的有效性和经济性。 设计：系统评价。方法：通过构建P（新生儿）、I［脉搏血氧饱和度（POX）］、R［心脏超声检查（ECHO）、手术］、O（新生儿mCHD）、S（成本分析法、成本效果分析、成本效用分析、成本效益分析）建立检索式,在Medline、Embase、Web of Science、The Cochrane Library、SinoMed、中国知网、万方数据库检索2000年至2022年4月28日的文献。通过阅读题目、摘要和全文筛选,提取文献基本信息,卫生经济学指标（评价方法、研究视角、成本收集范围、敏感性分析类型、贴现率）,卫生经济学评价结果［挽救1个生命年（LYS）的成本、获得1个质量调整生命年（QALY）的成本、避免1个伤残调整生命年（DALY）的成本、增加1例及时诊断出病例的成本和增量成本效果/效用比］。文献的质量评价采用卫生经济学评价质量评分量表（QHES）。主要结局指标：筛查成本和成本效果。结果：纳入2007至2020年11篇文献,能提取单纯POX筛查数据的文献7篇,能提取单纯CE和POX+CE筛查数据的文献各4篇,能提取POX+MUR筛查的文献1篇。社会角度2篇,医疗系统角度9篇;基于人群4篇,基于模型7篇;收集了直接成本和间接成本1篇,收集了直接成本10篇。基于2022年6月汇率折算美元,POX筛查的成本为2～24.5美元,其中人工成本为2.53～7.4美元,一次性探头成本为13.4～22美元,重复性探头成本为0.1～0.9美元。CE筛查的成本为 0.5~4.5美元。MUR筛查的成本为1.3~2.0美元。筛查阳性的病例行ECHO费用30~1 300美元。8篇文献采用CEA/CUA（成本效果/效用分析）进行筛查的成本效果分析,其中2篇评价POX筛查、5篇POX+CE筛查和1篇POX+MUR,不考虑人工成本的基础上使用一次性探头和ECHO费用是主要筛查成本;POX、POX+MUR和POX+CE具有成本效果,POX+MUR与ECHO相比更具有成本效果,ECHO+CE与POX+CE相比还能检出其他先天性缺陷则具有成本效果。结论：mCHD筛查成本主要体现在是否使用一次性探头和超声检查费用;POX、POX+MUR和POX+CE具有成本效果;不同经济发展水平mCHD筛查的经济性可接受。     

早产儿视网膜病发病情况及危险因素分析

目的探讨早产儿视网膜病(ROP)发病情况及影响ROP患病的危险因素。方法对2004-03—2005-12在北京大学第一医院新生儿监护室住院的胎龄≤34周和(或)出生体重≤2000g的早产儿在生后4~6周或校正胎龄至32周时进行眼底检查,并对相关危险因素进行分析。结果203例早产儿中有25例发生ROP,发生率为12.31%,7例出现阈值或阈值前病变需要治疗,占3.44%,Logistic回归分析表明小胎龄、低出生体重、母亲合并妊娠期糖尿病是发生ROP的危险因素,ROP组与正常眼底组在这三方面差异均有统计学意义(P<0.05)。结论小胎龄、低出生体重、母亲合并妊娠期糖尿病是发生ROP的危险因素。     

Hospital care techniques resulting in intact survival of a 380-g infant

Intact survival of infants delivered before completion of the 26th week of gestation or weighing less than 500 g is a well known phenomenon. We recently cared for an infant whose birth weight was 380 g, making her one of the smallest survivors in the United States. Her hospitalization (including expenses), the techniques of our minimal intervention protocol and her 20-month (corrected) follow-up are presented together with a discussion of the moral, economic and social implications involved in the care of such an infant.     

左氧氟沙星全身给药儿童骨关节不良事件的系统评价

目的系统评价左氧氟沙星全身给药对儿童骨关节不良事件的发生情况。方法计算机检索Pub Med、Cochrane图书馆、OVID、EBSCO、中国知网、中国维普科技期刊数据库和万方数据库,检索时间从1993年1月至2015年1月;同时手工检索中国《药品不良事件信息通报》、WHO Pharmaceuticals Newsletter和FDA Drug Safety Newsletter;还检索美国、中国和欧盟药品监督和管理部门的网站;获得儿童使用左氧氟沙星全身给药的不良事件资料。按照纳入和排除标准筛选文献。对纳入的RCT文献行偏倚风险评价。结果行描述性分析。结果检索获得286篇文献,11篇文献进入系统评价,包括RCT 5篇、病例系列/报告6篇和上市后药物不良事件监测2篇。美国FDA网站检索到25份关于儿童使用左氧氟沙星出现不良事件的报告。1RCT文献:2篇文献结果显示左氧氟沙星组与对照组骨关节不良事件发生率差异无统计学意义,3篇文献未报告骨关节不良事件;2病例系列/报告:3篇涉及左氧氟沙星骨关节不良事件,分别报告14例轻微的骨关节疼痛(14/26),跛行和踝关节痛各1例(2/204),掌指关节炎和踝关节痛各1例(2/5),骨关节炎症状均在停药或疗程结束后消失。3上市后药物不良事件监测:2篇文献(1项研究,n=2 233)报告左氧氟沙星骨关节损害(关节痛、关节炎、跟腱炎和步态异常)发生率在1.7%~3.4%,1年内骨关节损害发生率高于对照组,在2~5年随访时骨关节损害发生率与对照组相近;4美国FDA不良事件报告:8份报告的主要症状呈现为骨关节不良事件,其中6篇报告因信息不完整致因果关系无法评价,2篇评价为可能;5美国和中国FDA均批准6月龄儿童吸入性炭疽(暴露后)使用左氧氟沙星;欧盟药品管理局批准了6项儿童使用左氧氟沙星治疗囊性纤维化的试验。结论现有证据显示,儿童应用左氧氟沙星骨关节不良事件的发生率较低,且多数在随访中可以缓解;作为充分评估风险和利益后左氧氟沙星超说明书使用时提供参考。     

Prevalence of childhood obesity in Brazil: systematic review and meta-analysis

ObjectiveTo estimate the prevalence of childhood obesity in Brazil by means of a systematic review of representative studies.SourcesWe searched for population-based studies that assessed obesity in Brazilian children aged < 10 years in MEDLINE, EMBASE, Scopus and other sources up to September, 2019. Paired researchers selected studies, extracted data and assessed the quality of these studies. Meta-analysis of prevalence and confidence interval (95% CI) was calculated, weighted by the population sizes using Freeman-Tukey double-arccosine transformation. Heterogeneity (I²) and publication bias were investigated by meta-regression and Egger’s test, respectively.Summary of the findings53 studies were included (n = 122,395), which were held from 1986 to 2015 and limited mainly due to inadequate response rates. Prevalence of obesity in the three-decade period was of 8.2% ([95% CI]: 8.1–8.4%, I² = 98.5%). Higher prevalence was observed in boys (9.7% [9.4–9.9%], I² = 97.4%) than girls (7.3% [7.1−7.5%], I² = 96.1%). Prevalence increased according to the decade (1990: 6.5% [6.0–7.0 %], I² = 96.8%; 2000: 7.9% [7.7–8.0 %], I² = 98.8%; 2010: 12.0% [11.5–12.6 %], I² = 95.8%), and Brazilian region (Northeast: 6.4% [6.2−6.7%], I² = 98.1%; North: 6.7% [6.3−7.2%], I² = 98.8%; Southeast:10.6% [10.2−11.0%], I² = 98.2%; South: 10.1 [9.7−10.4%], I² = 97.7%). Heterogeneity was affected by age and region (p < 0.05) and publication bias was discarded (p = 0.746).ConclusionFor every 100 Brazilian children, over eight had obesity in the three-decade period and 12 in each 100 had childhood obesity in more recent estimates. Higher prevalence occurred in boys, recent decades and more developed Brazilian regions.     

Hepatoblastoma in low birth weight infants: an institutional review

The association between hepatoblastoma and low birth weight documented recently in the literature has yet to be well explained, in particular the suggestion that these patients may have a more aggressive form of the disease. From 1989 to 2003, our institution treated four patients for hepatoblastoma who had birth weights of less than 1,500 g. Notable was 100% patient survival despite bilateral and, in one case, recurrent disease. Speculation regarding the etiology of this subset of hepatoblastoma has included damage to developing hepatocytes induced by oxygen free radicals. Our patients universally had pulmonary disease requiring prolonged supplemental oxygen and ventilatory support. However, our review supports no changes in the standard care of low birth weight infants or in managing those who develop hepatoblastoma.     

A study on the health status of twin babies

A study on twin births was conducted from May 1993 to April 1994 at S.A.T. Hospital, Thiruvananthapuram. The twinning rate in this period was found as 17.33 per 1000 births. 79.6% babies in the twin pairs were of like sex and 20.4% were of unlike sex. The incidence of low birth weight twin babies in this study was 68.9%. There was no significant difference in the physical parameters (birth weight, body length and head circumference) of twin babies in relation to sex. The incidence of twin birth was higher among primipara mothers and in the mothers of age group 21 to 25 years. The first born baby (twin A) was found to be heavier than the second born baby (twin B) in 44.78% twin pairs and their mean birth weight difference was 438 g, while the second born baby (twin B) was found to be heavier than the first born (twin A) in 38.31% twin pairs and their mean birth weight difference was 291 g. Statistical analysis showed that the difference between the mean birth weight difference in the case of twin A>B was significantly greater when compared to that of twin A<B.     

The predictive validity of general movements – A systematic review

BackgroundThe assessment of general movements (GMs), introduced by Professor Heinz Prechtl and his co-workers in the early 1990s, may offer the opportunity to identify infants with neurological deficits at a very early age.AimThe aim of this review was to systematically assess available data in order to determine the evidence of general movements in early infancy to predict the neurodevelopmental outcome in 12- and 24-month-old infants.MethodA systematic literature search was performed using the following computerised databases: Medline, CINAHL, Pedro, The Cochrane Library, Science Direct, ProQuest: Science Journals, Medical Library &; Social Science Journals, Journals @ OVID and PsycINFO. The following key terms were used: general movements, spontaneous motor activity, nervous system diseases [MeSH] and developmental disabilities [MeSH]. A comprehensive author search was also conducted. The methodological quality of eligible studies was critically appraised by two reviewers using the Critical Review Form for Quantitative Studies of the McMaster University Occupational Therapy Evidence-Based Practice Research Group.ResultsSeventeen studies were eligible for this review. The average score of the studies was 8.82 (73.5%) from a total of 12 (SD 0.73). Fifteen of the 17 studies found a high relationship (sensitivity ≥ 92%; specificity ≥ 82%; p < 0.01) between the quality of general movements at 8–20 weeks postterm (fidgety movements' period) and the infants' neurodevelopmental outcome.ConclusionThe results of this systematic review indicate that the qualitative assessment of general movements, especially during the fidgety movements' period, can be used as a prognostic tool to identify infants with neurodevelopmental disabilities.     

Predictors of excess birth weight in Brazil: a systematic review

Objective

To describe the main predictors for excess birth weight in Brazilian children.